Columbia Gas Transmission LLC

Third Revised Volume No. 1

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Effective Date: 03/03/2009, Docket: RP09-340-000, Status: Effective

Original Sheet No. 568 Original Sheet No. 568

REQUEST FOR SEGMENTATION

OF EXISTING TRANSPORTATION SERVICE AGREEMENT

COLUMBIA GAS TRANSMISSION, LLC

1. Changes are applicable to:

Rate Schedule Agreement No.

2.

a. Identity of Requestor

Legal company name

Abbreviation or Short Name (if applicable)

Phone Number

Facsimile Number

E-mail Service _______________________________________________

b. Identity of Shipper (if different than Requestor)

Written documentation must be submitted to support Requestor's legal

authorization to negotiate and/or bind the Shipper contractually.

Legal company name

Abbreviation or short name (if applicable)

Phone Number

Facsimile Number

E-mail Service ________________________________________________

3. Requested beginning date for segmentation

/ /

4. Requested ending date for segmentation

/ /